TCEQ 10002 (APDG 5723v15, Revised 01/18) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page 1 of 10

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 - Instructions

Owners or operators of a site required to obtain a federal operating permit (FOP), in accordance with Title 30 Texas Administrative Code Chapter 122 (30 TAC Chapter 122), must complete and submit an FOP application to the Texas Commission on Environmental Quality (TCEQ), Office of Permitting and Registration, Air Permits Division (APD), and a copy must be submitted to the appropriate TCEQ regional office. There are three types of FOPs, and they are as follows: site operating permit (SOP), temporary operating permit (TOP), and general operating permit (GOP). Information on these permit types can be found on the TCEQ website at www.tceq.texas.gov/permitting/air/titlev/permit_types.html.

For submissions to EPA: EPA Region 6 office has requested that all applications, including any updates, submitted to EPA be provided in electronic format via email or as a readable media via CD, DVD, or flash drive by mail. Microsoft Word for text, Excel for spreadsheets, and a searchable Adobe Acrobat (pdf) file are the preferred formats. Do not submit any compressed or zip files, files with an “.exe” extension or files that contain any confidential information. Do not submit any individual files larger than 10 megabytes via email, and the total size of all attachments cannot exceed 25 megabytes per email. With the exception of any document that requires an original signature or confidential information, no hard copies of the information contained in the application should be submitted to EPA.

Any application, including any updates, submitted via email should be submitted to EPA at: R6AirPermitsTX@epa.gov. Identify the associated permit number when submitting information.

All confidential information, documents with original signature, and readable media, CD, DVD, or flash drive, should be mailed to:

Environmental Protection Agency, Region 6 Air Permits Section (6MM-AP) 1445 Ross Avenue, Suite 1200 Dallas, Texas 75202-2733

Please contact Ms. Aimee Wilson (wilson.aimee@epa.gov) at (214) 665-7596 if you have any questions pertaining to electronic submittals.

General:

The purpose of this form is to provide general information regarding the company, site, and area for which an FOP application is being submitted. This form is required for all initial and renewal FOP applications. This form is only required for FOP revision applications if the information on this form has changed. FOP revision and renewal applications must include Form OP-2 (Application for Permit Revision/Renewal), at a minimum.

Note: For a change of company name or ownership only, submit TCEQ Form Number 20405. Form OP-1 is not required.

For initial FOP issuance only, an abbreviated application (at a minimum) must be submitted in accordance with 30 TAC § 122.130. An abbreviated application consists of Form OP-1 (Site Information Summary), Form OP-CRO1 (Certificationby Responsible Official), and a TCEQ Core Data Form. In accordance with 30 TAC § 122.130, the executive director willinform the applicant in writing of the deadline for submitting the remaining application information (full application).

Information regarding SOP application requirements can be found on TCEQ's Air Site Operating Permit Guidance webpage located at www.tceq.texas.gov/permitting/air/guidance/titlev/tv_site_guidance.html. Information regarding GOP application requirements can be found on TCEQ's Air General Operating Permit Guidance webpage located at www.tceq.texas.gov/permitting/air/guidance/titlev/tv_gop_guidance.html.

OP-1 Instructions

TCEQ 10002 (APDG 5723v15, Revised 01/18 OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page 2 of 10

Submitting a timely and complete application, as defined in 30 TAC §§ 122.133 and 122.134, is critical and allows the applicant to receive the benefit of an application shield, as defined in 30 TAC § 122.138. The application shield serves as authorization to operate the site until final action is taken on the application. Failure to supply any information requested by the TCEQ, pursuant to the application review, may result in loss of the application shield.

The responses to most data elements in Form OP-1 are limited in some way. Responses not made according to the instructions may result in delays in this or other permitting actions.

1) Some responses have a character limit. (Example: “Company Name,” maximum 50 characters.) The responses mayconsist of characters, digits, or a combination of the two. When appropriate, common abbreviations can be used tofit a response into the space allotted.

2) Some responses are limited to “YES” or “NO” and in some cases “N/A” for “not applicable.” Applicants mustselect one of these options. “N/A” is an acceptable response only when it is stated in the instructions for thequestion.

3) Some responses must be in a specific format. (Examples: Dates, MM/DD/YYYY; Latitude/Longitude,DDD:MM:SS.)

4) Some responses are limited to a set of mutually exclusive response options, and selections are recorded by placingan “X” in the box next to the appropriate response. (Example: “Permit Type.”)

The TCEQ requires that a Core Data Form be submitted on all incoming registrations unless a Regulated Entity and Customer Reference Number have been issued by the TCEQ and no core data information has changed. For more information regarding the Core Data Form, call (512) 239-5175 or go to the TCEQ Web site at: www.tceq.texas.gov/permitting/central_registry/guidance.html.

Specific:

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I. Company Identifying Information

A. Company Name: Enter the name of the company for which the application is being submitted(maximum 50 characters). The company name should be the name used to incorporate, for which afranchise tax identification number has been issued. If a franchise tax identification number has not beenissued, then enter the most identifying name for the company. The company name on this form and theTCEQ Core Data Form should match.

B. Customer Reference Number (CN): Enter the customer reference number (CNXXXXXXXXX). Thisnumber is issued by the TCEQ as part of the central registry process. If a customer reference number hasnot yet been issued, leave this space blank. Do not enter permit numbers, project numbers, accountnumbers, etc., in this space.

C. Submittal Date: Enter the date the application is being submitted by the applicant to the TCEQ(MM/DD/YYYY).

II. Site Information

A. Site Name: Enter the name of the site for which the application is being submitted (maximum50 characters). The Site Name on this form and the Regulated Entity Name listed in Section III of theTCEQ Core Data Form should match.

B. Regulated Entity Reference Number (RN): Enter the regulated entity reference number for the site(RNXXXXXXXXX). This number is issued by the TCEQ as part of the central registry process. If aregulated entity reference number has not yet been issued, leave this space blank. Do not enter permitnumbers, project numbers, account numbers, etc., in this space.

OP-1 Instructions

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C. Primary TCEQ Account Number for Site: Enter the primary TCEQ account number for the site ifissued (XX-XXXX-X). If an account number was not issued, leave this space blank.

D. Indicate Affected State(s) Required to Review Permit Application: As stated in 30 TAC§ 122.330(b), an affected state may be New Mexico (NM), Oklahoma (OK), Kansas (KS), Colorado(CO), Arkansas (AR), or Louisiana (LA) if the state’s air quality may be affected by the issuance ordenial of a federal operating permit, revision, or renewal; or that state is within 50 miles of the site.

Place an “X” in the space to the right of the affected state(s) that is applicable. Place an “X” to the right of “N/A” if affected state review is not applicable.

GOP applications do not require affected state review. Therefore, all GOP applicants should place an “X” to the right of “N/A.”

E. Indicate all pollutants for which the site is a major source based on the site’s potential to emit: Enter“YES” below all of the pollutants for which the site is classified as a major source, as defined in 30 TAC§ 122.10, based on the site’s potential to emit. Enter “NO” below all of the pollutants for which the site isnot a major source. Do not leave any spaces blank.

The column “Other” is provided for listing of non-criteria regulated air pollutants for which a site is a major source. (Example: chlorinated compounds, inorganic acids) List the pollutant name in the space provided (maximum 20 characters). List greenhouse gases (GHG) only if the site is required to obtain a GHG PSD permit. If there are none, leave this space blank.

Further information regarding potential to emit can be found in the Potential to Emit Guidance, which is located on the TCEQ website at www.tceq.texas.gov/permitting/air/guidance/titlev/tv_fop_guidance.html

F. Is the Source a Non-Major Source Subject to the Federal Operating Permit Program? Enter “YES”if the site is a non-major source (or area source) subject to the Federal Operating Permit Program.Otherwise, enter “NO.” (Note that if the response to this question is “YES,” then the responses toquestion II.E above should all be “NO.”)

G. Is the Site Within a Local Program Area Jurisdiction? Enter “YES” if the site is located within thejurisdiction of a local air pollution control program. Otherwise, enter “NO.”

A list of local air pollution control programs is located on the TCEQ websiteat www.tceq.texas.gov/permitting/air/local_programs.html

H. Will Emissions averaging be used to Comply with any Subpart of 40 CFR Part 63? Enter “YES” ifemissions averaging will be used by an affected source at the site to comply with any Title 40 Code ofFederal Regulations Part 63 (40 CFR Part 63) requirement, relating to National Emission Standards forHazardous Air Pollutants for Source Categories that has been promulgated at the time of applicationsubmittal. Otherwise, enter “NO.”

Emissions averaging, as defined in 40 CFR § 63.2, is a way to comply with the emission limitationsspecified in a relevant standard, whereby an affected source, if allowed under a subpart of this part, maycreate emission credits by reducing emissions from specific points to a level below that required by therelevant standard, and those credits are used to offset emissions from points that are not controlled to thelevel required by the relevant standard.

I. Indicate the 40 CFR Part 63 Subpart(s) that will use Emissions Averaging: If emissions averagingwill be used by an affected source at the site to comply with any 40 CFR Part 63, enter the subpartdesignation (Example: N, P, CC, KK) in the boxes provided. Use a separate box for each subpartdesignation that will use emissions averaging. Enter “N/A” in the first box provided if emissionsaveraging will not be used.

OP-1 Instructions

III. Permit Type:

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A. Type of Permit Requested: Indicate the type of permit for which this application is being submitted byplacing an “X” in the space to the right of the selection (SOP, TOP, or GOP). Select only one response.

Information on the different permit types can be found on the TCEQ websiteat www.tceq.texas.gov/permitting/air/titlev/permit_types.html

IV. Initial Application Information (Complete for Initial Issuance Applications only.)

A. Is this Submittal an Abbreviated or Full Application? Indicate the type of application (“Abbreviated”or “Full”) by placing an “X” in the space to the right of the selection.

Abbreviated applications must be submitted in accordance with 30 TAC § 122.130. An abbreviatedapplication only includes Form OP-1, Form OP-CRO1 (Certification by Responsible Official), and theTCEQ Core Data Form. If the submitted application is not an abbreviated application, select “Full.”

B. If this is a Full Application, is this Submittal a Follow-up to an Abbreviated Application? Enter“YES” if this submittal is a full application, which is being submitted in response to a request forfollow-up information regarding an abbreviated application that was submitted earlier. If this submittal isa full application (Application Type = “Full”) and no abbreviated application was submitted earlier, enter“NO.” If this submittal is an abbreviated application (Application Type = “Abbreviated”), leave this spaceblank.

C. If this is an Abbreviated Application, is this an early submittal for a Combined SOP and Acid Rainpermit? Enter “YES” if this submittal is an early submittal for a combined SOP and Acid Rain permit.Enter “NO” if this submittal is not an early submittal for a combined SOP and Acid Rain permit. If thissubmittal is a full application (Application Type = “Full”), leave this space blank.

D. Has a copy of this application been submitted (or is being submitted) to EPAat R6AirPermitsTX@epa.gov? Enter “YES” if a copy of this application has been submitted (or isbeing submitted) to EPA. If not, enter “NO.” (See “For submissions to EPA” above for additionalinformation.)

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V. Confidential Information

A. Is confidential information submitted in conjunction with this application? Enter “YES” if anyconfidential information is being submitted in conjunction with this application. Otherwise, enter “NO.”All confidential information must be submitted according to the TCEQ guidance locatedat www.tceq.texas.gov/permitting/air/titlev/apps_timelines.html#confidential

VI. Responsible Official (RO) Identifying Information

The RO must be listed in this section even if the duties will be delegated to a Duly Authorized Representative(DAR). The DAR information should be provided on the Form OP-DEL (Delegation of Responsible Official).Additional information on Responsible Official and Certification can be found on the TCEQ websiteat www.tceq.texas.gov/permitting/air/titlev/ro_and_certs.html

Note: For change of RO and RO information, Form OP-CRO2 (Change of Responsible Official) must besubmitted to the TCEQ.

A. RO Name: Place an “X” next to the appropriate conventional title (Mr./Mrs./Ms./Dr.). Enter the name ofthe RO pursuant to 30 TAC § 122.132(e) and 30 TAC § 122.165 (Last Name, First Name, MI;maximum 25 characters).

OP-1 Instructions

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B. RO Title: Enter the title of the RO (maximum 60characters).

C. Employer Name: Enter the name of the company, firm, etc. that employs the RO(maximum 50 characters). The company or firm name should be the name used to incorporate, for whicha franchise tax identification number has been issued. If a franchise tax identification number has notbeen issued, then enter the most identifying name for the company or firm.

D. Mailing Address: Enter the RO mailing address, including city, state, and ZIP Code (mailing addressmaximum 50 characters and city maximum 25 characters). If the mailing address is not within the UnitedStates, enter the territory, country, and foreign postal code, rather than the state and ZIP Code.

E. Internal Mail Code: Enter the internal mail code that is part of the mailing address, if applicable(maximum 10 characters).

F. Telephone: Enter the RO telephone number with area code.

G. Fax: Enter the RO fax number with area code.

H. E-mail: Enter the electronic mail address for the RO (maximum 30 characters).

VII. Technical Contact Identifying Information (Complete if different from RO information.)

A. Technical Contact Name: Place an “X” next to the appropriate conventional title (Mr./Mrs./Ms./Dr.).Enter the name of the technical contact for this application, if different from the RO (Last Name, FirstName, MI; maximum 25 characters).

If the technical contact is the same as the RO, enter “SAME” in this space and proceed to Section VIII,leaving questions VII.B-J blank.

B. Technical Contact Title: Enter the title of the technical contact (maximum 60characters).

C. Employer Name: Enter the name of the company, firm, etc. that employs the technical contact(maximum 50 characters). The company or firm name should be the name used to incorporate, for whicha franchise tax identification number has been issued. If a franchise tax identification number has notbeen issued, then enter the most identifying name for the company or firm.

D. Mailing Address: Enter the technical contact mailing address, including city, state, and ZIP Code(mailing address maximum 50 characters and city maximum 25 characters). If the mailing address is notwithin the United States, enter the territory, country, and foreign postal code rather than the state andZIP Code.

E. Internal Mail Code (Mailing Address): Enter the internal mail code that is part of the mailing address,if applicable (maximum 10 characters).

F. Telephone: Enter the telephone number for the technical contact including area code.

G. Fax: Enter the technical contact fax number with area code.

H. E-mail: Enter the electronic mail address (maximum 30 characters).

OP-1 Instructions

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VIII. Reference Only Requirements (For reference only.)

Certification by the RO pursuant to 30 TAC § 122.165 does not extend to information which is designated onforms as “For reference only.”

A. State Senator: Enter the name of the state senator representing the area in which the site is located(maximum 25 characters)

TCEQ will send notification of the receipt of a permit application to the state senator for the area in whichthe site is located. State senator information may be obtained by contacting the State Senate at(512) 463-0100 or the Legislative Reference Library at (512) 463-1252. Information may also be obtainedvia the Texas Senate Internet site at www.legis.state.tx.us/.

B. State Representative: Enter the name of the state representative representing the area in which the site islocated (maximum 25 characters).

TCEQ will send notification of the receipt of a permit application to the state representative for the area inwhich the site is located. State representative information may be obtained by contacting the House ofRepresentatives at (512) 463-4630 or the Legislative Reference Library at (512) 463-1252. Informationmay also be obtained via the House of Representatives Internet site at www.legis.state.tx.us/

C. Has the Applicant Paid Emissions Fees for the Most Recent Agency Fiscal Year? Enter “YES” if theapplicant has paid all emissions fees, or inspection fees, if applicable, due during the most recent agencyfiscal year (September 1 - August 31). Otherwise, enter “NO.” If the applicant is not required to payemissions fees, enter “N/A.”

If the answer to VIII.C. is “NO” or “NA,” the applicant is required to contact the Industrial EmissionsAssessment Section at (512) 239-1459. For further information regarding inspection fees and emissionfees, please refer to 30 TAC §§ 101.24 and 101.27.

D. Is the site subject to bilingual notice requirements pursuant to 30 TAC § 122.322? Enter “YES” ifthe site is subject to the bilingual notice requirements pursuant to 30 TAC § 122.322. Otherwise, enterNO.”

The requirements of 30 TAC § 122.322 are applicable when either the elementary school or the middleschool located nearest to the facility, or proposed facility, provides a bilingual education program, asrequired by Texas Education Code § 29.053 and 19 TAC § 89.1205(a) (relating to Required BilingualEducation and English as a Second Language Programs), or if either school has waived out of such arequired bilingual education program under the provisions of 19 TAC § 89.1205(g). Schools not governedby the provisions of 19 TAC § 89.1205 should not be considered when determining the applicability of30 TAC § 122.322 requirements.

Elementary or middle schools that offer English as a second language under 19 TAC § 89.1205(d), andare otherwise not affected by 19 TAC § 89.1205(a), will not trigger the requirements of 30 TAC§ 122.322(a).

OP-1 Instructions

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E. Indicate the alternate language(s) in which public notice is required: If the answer to the previousquestion is “YES,” enter the alternate language(s) for which public notice is required in the spaceprovided.

Please use a separate page to indicate the alternate languages if additional space is required. If the answerto the previous question is “NO,” enter “NONE”.

Examples:

D. Is the site subject to bilingual notice requirements pursuant to 30 TAC § 122.322? YES

E. Indicate the alternate language(s) in which public notice is required: Spanish, Vietnamese, German

D. Is the site subject to bilingual notice requirements pursuant to 30 TAC § 122.322? NO

E. Indicate the alternate language(s) in which public notice is required: NONE

F. RO is opting out of electronic correspondence from TCEQ (otherwise leave blank): Check the “Opt-Out of E-mailed Docs” box if the RO would like to continue receiving correspondence from TCEQ forthis project through the mail instead of through electronic mail. Otherwise, leave blank.”

If this question is left blank the default process is to send electronic correspondence for this project. Thismeans that TCEQ will send all documents via electronic mail that would have otherwise been mailed. Avalid e-mail address for the Responsible Official in question VI.H is required if this question is left blank.

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IX. Off-Site Permit Request (Optional)

Complete this section only if the applicant wishes to maintain the FOP and records at a location other than thesite designated in the “Site Information” section of this form.

A. Office/Facility Name: Enter the name of the office or facility where the FOP and records are to be held(maximum 50 characters).

B. Physical Address: Enter the physical address of the office or facility, including city, state, and ZIP Code(physical address maximum 50 characters; city - maximum 25 characters). The physical address cannotbe a Post Office Box.

C. Physical Location: If a physical address does not exist, provide a description of the physical location ofthe office or facility where the permit is to be held (maximum 50 characters). (Example: Highway100, 2 miles west of County Road 12.) Leave Physical Location blank if there is a Physical Address.

D. Contact Name: Place an “X” next to the appropriate conventional title (Mr./Mrs./Ms./Dr.). Enter thename of a contact person at the office or facility where the FOP and records are to be held (optional)(maximum 50 characters).

E. Telephone: Enter the telephone number with area code of the contact person.

OP-1 Instructions

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X. Application Area Information

This section pertains to the application area. If only one application is being submitted (or was submitted) for theentire site, then the following information relates to the site as a whole.

A. Area Name: Enter the name of the application area (maximum 50 characters). If more than one permit isproposed for the site, the area name should be descriptive enough to provide a clear distinction of theportion of the site covered under this application. (Examples: “Tank Battery #1,” “North LoadingArea”.) If there is only one permit proposed for the site, the area name must be the same as the site namein the “Site Information” section of this form. Note that the area may refer to a subset of units at the siteto be covered by an application; it need not refer to a distinct physical area. This name will eventually beused as the name for the permit.

B. Physical Address: Enter the physical address of the application area, including city, state, and ZIP Code(physical address maximum 50 characters; city - maximum 25 characters).

If there is a Physical Address, skip X.C-F below.

C. Physical Location: If a physical address does not exist, provide a description of the physical location ofthe application area (maximum 50 characters). (Example: Highway 100, 2 miles west ofCounty Road 12.)

D. Nearest City: Enter the name of the city or municipality nearest to the application area, or in which theapplication area is located (maximum 25 characters).

E. State: Enter the state in which the nearest city is located.

F. ZIP Code: Enter the ZIP Code of the application area. (This is used for location purposes and must beprovided even if the facility does not receive mail delivery.)

G. Latitude: Enter the latitude coordinate for the application area (DDD:MM:SS). Latitude indicates theangular distance (in degrees) of a location north of the equator and will always be between 25 and37 degrees in Texas. Coordinates of the area must be shown to the nearest second and can be obtainedfrom most city engineers, U.S. Geological Survey (USGS) maps, or from county maps prepared by theTexas Department of Transportation (TxDOT).

H. Longitude: Enter the longitude coordinate for the application area (DDD:MM:SS). Longitude indicatesthe angular distance (in degrees) of a location west of the prime meridian and will always be between93 and 107 degrees in Texas. Coordinates of the area must be shown to the nearest second and can beobtained from most city engineers, USGS maps, or from county maps prepared by the TxDOT.

I. Are there any emission units that were not in compliance with the applicable requirementsidentified in the application at the time of application submittal? Enter “YES” if there are one ormore emission units in the application area that are out of compliance. “Out of compliance” means asituation in which an emission unit or an operating condition may not be in compliance with one or moreapplicable requirements. Information on these units will be forwarded to the appropriate regional office.Title 30 TAC Chapter 122 requires that a description of the compliance status for all emission units beprovided in a full application. Additional compliance information for full applications is provided onForm OP-ACPS (Application Compliance Plan and Schedule). If all emission units in the application areaare believed to be in compliance, enter “NO.”

J. Estimated number of emission units in application area: Enter an estimated number of emission unitsin the application area with potentially applicable requirements. Do not include emission units that willonly be addressed on Form OP-REQ1 (Application Area-wide Applicability Determinations and GeneralInformation).

K. Are there any emission units in the application area subject to the Acid Rain Program? Enter“YES” if any emission units in the application area are subject to the Acid Rain Program (ARP),including the Opt-in Program. Otherwise, enter “NO.”

OP-1 Instructions

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If the response to this question is “YES,” submit the appropriate forms for an acid rain permit, if not already submitted. Applications for acid rain permits for opt-in sources to the ARP shall be submitted in accordance with 40 CFR Part 74.

The Opt-in Program allows stationary combustion sources not required to participate in the ARP the opportunity to enter the program on a voluntary basis, reduce their sulfur dioxide (SO2) emissions, and receive their own acid rain allowances. Combustion sources are defined as fossil fuel-fired boilers, turbines, or internal combustion engines. An opt-in source must comply with the same or similar provisions as utility units affected under the mandatory ARP. These provisions relate to allowance trading, permitting, excess emissions, monitoring, end-of-year compliance and enforcement. Most basic to the program is the requirement that each year the opt-in source must hold enough allowances to cover its annual SO2 emissions. For additional information, please refer to 40 CFR Part 74.

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XI. Public Notice

Complete this section for SOP Applications (initial, renewal, and significant revision) and Acid Rain PermitApplications only.

A. Name of public place to view application and draft permit: Enter the name of the public place wherethe application and draft permit will be available for review and copying by the public throughout thepublic notice period.

The public place must be publicly owned or operated, such as a library, courthouse, or city hall, and mustbe located in the same county as the site. The TCEQ Regional Office may be used as the public place if itis located in the same county as the site.

B. Physical Address: Enter the public place physical address, including city and ZIP Code (physicaladdress maximum 50 characters; city maximum 25 characters).

C. Contact Person: Place an “X” next to the appropriate conventional title (Mr./Mrs./Ms./Dr.). Enter thename of the contact person who will answer questions from the public during the Public Notice Period(Last Name, First Name, MI; maximum 25 characters). This information will be published in thenewspaper notice.

D. Contact Mailing Address: Enter the mailing address of the contact person, including city, state, andZIP Code (address - maximum 50 characters; city - maximum 25 characters). If the mailing address is notwithin the United States, enter the territory, country, and foreign postal code, rather than the state andZIP Code.

E. Internal Mail Code (Mailing Address): Enter the internal mail code that is part of the mailing addressof the contact person, if applicable (maximum 10 characters).

F. Telephone: Enter the telephone number with area code of the contact person (optional). This informationwill be published in the newspaper notice.

OP-1 Instructions

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XII. Delinquent Fees and Penalties

Notice: This form will not be processed until all delinquent fees and/or penalties owed to the TCEQ or the Officeof the Attorney General on behalf of the TCEQ are paid in accordance with the “Delinquent Fee and PenaltyProtocol.” For more information regarding Delinquent Fees and Penalties, go to the TCEQ Web siteat www.tceq.texas.gov/agency/delin/index.html

Complete Sections XIII and XIV for Acid Rain Permit and CSAPR applications only. Please include a copy of the Certificate of Representation submitted to EPA.

XIII. Designated Representative (DR) Identifying Information

A. DR Name: Place an “X” next to the appropriate conventional title (Mr./Mrs./Ms./Dr.). Enter the name ofthe DR pursuant to 30 TAC § 122.165 (Last Name, First Name, MI; maximum 25 characters).

B. DR Title: Enter the title of the DR (maximum 25 characters).

C. Employer Name: Enter the name of the company, firm, etc. that employs the DR(maximum 50 characters). The company or firm name should be the name used to incorporate, for whicha franchise tax identification number has been issued. If a franchise tax identification number has notbeen issued, then enter the most identifying name for the company or firm.

D. Mailing Address: Enter the DR mailing address, including city, state, and ZIP Code (mailing addressmaximum 50 characters and city maximum 25 characters). If the mailing address is not within the UnitedStates, enter the territory, country, and foreign postal code, rather than the state and ZIP Code.

E. Internal Mail Code: Enter the internal mail code that is part of the mailing address, if applicable(maximum 10 characters).

F. Telephone: Enter the DR telephone number with area code.

G. Fax: Enter the DR fax number with area code.

H. E-mail: Enter the electronic mail address for the DR (maximum 30 characters). Leave blank if theelectronic mail address is not available or electronic mail is not used.

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XIV Alternate Designated Representative (ADR) Identifying Information

A. ADR Name: Place an “X” next to the appropriate conventional title (Mr. /Mrs./Ms./Dr.). Enter the name ofthe ADR pursuant to 30 TAC § 122.165 (Last Name, First Name, MI; maximum 25 characters). If there isno ADR, leave this section blank.

B. ADR Title: Enter the title of the ADR (maximum 25 characters).

C. Employer Name: Enter the name of the company, firm, etc. that employs the ADR (maximum50 characters). The company or firm name should be the name used to incorporate, for which a franchisetax identification number has been issued. If a franchise tax identification number has not been issued, thenenter the most identifying name for the company or firm.

D. Mailing Address: Enter the ADR mailing address, including city, state, and ZIP Code (mailing addressmaximum 50 characters and city maximum 25 characters). If the mailing address is not within the UnitedStates, enter the territory, country, and foreign postal code, rather than the state and ZIP Code.

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E. Internal Mail Code: Enter the internal mail code that is part of the mailing address, if applicable(maximum 10 characters).

F. Telephone: Enter the ADR telephone number with area code.

G. Fax: Enter the ADR fax number with area code.

H. E-mail: Enter the electronic mail address for the ADR (maximum 30 characters). Leave blank if theelectronic mail address is not available or electronic mail is not used.

TCEQ 10002 (APDG 5723v15, Revised 01/18) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page _____ of _____

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 (Page 1)

Please print or type all information. Direct any questions regarding this application form to the Air Permits Division at (512) 239-1250. Address written inquiries to the Texas Commission on Environmental Quality, Office of Air, Air PermitsDivision (MC 163), P.O. Box 13087, Austin, Texas 78711-3087.

I. Company Identifying Information

A. Company Name:

B. Customer Reference Number (CN): CN

C. Submittal Date (mm/dd/yyyy):

II. Site Information

A. Site Name:

B. Regulated Entity Reference Number (RN): RN

C. Primary Account Number for Site:

D. Indicate affected state(s) required to review permit application: (Check the appropriate box[es].)

AR CO KS LA NM OK N/A

E. Indicate all pollutants for which the site is a major source based on the site’s potential to emit:

Pollutant VOC NOX SO2 PM10 CO Pb HAPS Other

Major at the Site (YES/NO):

F. Is the source a non-major source subject to the Federal Operating Permit Program? YES NO

G. Is the site within a local program area jurisdiction? YES NO

H. Will emissions averaging be used to comply with any Subpart of 40 CFR Part 63? YES NO

I. Indicate the 40 CFR Part 63 Subpart(s) that will use emissions averaging:

III. Permit Type

A. Type of Permit Requested: (Select only one response )

Site Operating Permit (SOP) Temporary Operating Permit (TOP) General Operating Permit (GOP)

IV. Initial Application Information (Complete for Initial Issuance Applications only.)

A. Is this submittal an abbreviated or a full application? Abbreviated Full

B. If this is a full application, is the submittal a follow-up to an abbreviated application? YES NO

C. If this is an abbreviated application, is Acid Rain permit?

this an early submittal for a combined SOP and YES NO

D. Has a copy of this application been submitted (or is being submitted) to the form instructions for additional information.)

to EPA? (Refer YES NO

TCEQ 10002 (APDG 5723v15, Revised 01/18) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page _____ of _____

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 (Page 2)

V. Confidential Information

A. Is confidential information submitted in conjunction with this application? YES NO

VI. Responsible Official (RO)

A. RO Name: ( Mr. Mrs. Ms. Dr.)

B. RO Title:

C. Employer Name:

D. Mailing Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

E. Internal Mail Code:

F. Telephone No.:

G. Fax No.:

H. E-mail:

VII. Technical Contact Identifying Information (Complete if different from RO.)

A. Technical Contact Name: ( Mr. Mrs. Ms. Dr.)

B. Technical Contact Title:

C. Employer Name:

D. Mailing Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

E. Internal Mail Code:

F. Telephone No.:

G. Fax No.:

H. E-mail:

TCEQ 10002 (APDG 5723v15, Revised 01/18) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page _____ of _____

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 (Page 3)

VIII. Reference Only Requirements (For reference only.)

A. State Senator:

B. State Representative:

C. Has the applicant paid emissions fees for (Sept. 1 - August 31)?

the most recent agency fiscal year YES NO N/A

D. Is the site subject to bilingual notice requirements pursuant to 30 TAC § 122.322? YES NO

E. Indicate the alternate language(s) in which public notice is required:

F. RO is opting out leave blank):

of electronic correspondence from TCEQ (otherwise Opt-Out of E-mailed Docs

IX. Off-Site Permit Request(Optional for applicants requesting to hold the FOP and records at an off-site location.)

A. Office/Facility Name:

B. Physical Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

C. Physical Location:

D. Contact Name: ( Mr. Mrs. Ms. Dr.)

E. Telephone No.:

X. Application Area Information

A. Area Name:

B. Physical Address:

City: State: ZIP Code:

C. Physical Location:

D. Nearest City:

E. State:

F. ZIP Code:

G. Latitude (nearest second):

H. Longitude (nearest second):

I. Are there any emission units that were not in compliance with the applicablerequirements identified in the application at the time of application submittal? YES NO

J. Indicate the estimated number of emission units in the application area:

K. Are there any emission units in the application area subject to the Acid Rain Program? YES NO

TCEQ 10002 (APDG 5723v15, Revised 01/18) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page _____ of _____

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 (Page 4)

XI. Public Notice(Complete this section for SOP Applications and Acid Rain Permit Applications only.)

A. Name of public place to view application and draft permit:

B. Physical Address:

City: ZIP Code:

C. Contact Person (Someone who will answer questions from the public, during the public notice period):

( Mr. Mrs. Ms. Dr.):

D. Contact Mailing Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

E. Internal Mail Code:

F. Telephone No.:

XII. Delinquent Fees and Penalties

Notice: This form will not be processed until all delinquent fees and/or penalties owed to the TCEQ or the Office of Attorney General on behalf of the TCEQ are paid in accordance with the “Delinquent Fee and Penalty Protocol.”

Complete Sections XIII and XIV for Acid Rain Permit and CSAPR Certificate of Representation submitted to EPA.

applications only. Please include a copy of the

XIII. Designated Representative (DR) Identifying Information

A. DR Name: ( Mr. Mrs. Ms. Dr.)

B. DR Title:

C. Employer Name:

D. Mailing Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

E. Internal Mail Code:

F. Telephone No.:

G. Fax No.:

H. E-mail:

TCEQ 10002 (APDG 5723v15, Revised 12/17) OP-1 This form is for use by sources subject to air quality permit requirements and may be revised periodically. Page _____ of _____

Texas Commission on Environmental Quality Federal Operating Permit Program

Site Information Summary Form OP-1 (Page 5)

XIV. Alternate Designated Representative (ADR) Identifying Information

A. ADR Name: ( Mr. Mrs. Ms. Dr.)

B. ADR Title:

C. Employer Name:

D. Mailing Address:

City: State: ZIP Code:

Territory: Country: Foreign Postal Code:

E. Internal Mail Code:

F. Telephone No.:

G. Fax No.:

H. E-mail: